記述言語：日本語   出版者・発行元：(株)全日本病院出版会  

本稿は大腿後面の血管解剖学的特徴とその中での異なる皮弁の解説に焦点を当てた.大腿部後面の皮弁は分厚い軟部組織を多く採取でき会陰骨盤底や乳房再建に多く用いられる.特に大腿深動脈,内側大腿回旋動脈の血管走行,周囲の筋肉についての解剖を十分に理解しておくことは重要である.Posterior thigh perforator flapと薄筋皮弁(gracilis flap)は様々な再建に用いられており,皮島のデザインも多彩である.大腿後面部の皮弁のそれぞれの解剖学的特徴や挙上時の注意点について詳細に説明した.(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Polyglycolic acid (PGA) sheets have been used with fibrin glue to cover extensive mucosal defects in oral and pharyngeal surgery; however, the sheets can fall off before wound healing is completed. Hence, prolonged fasting is often recommended in such patients. However, there are few studies on the factors that shape PGA sheet engraftment. We studied sheet engraftment rates considering these factors. METHODS: All consecutive cases of oral surgery in 2013-21 in which the defect was covered with fibrin glue and Neoveil® or Neoveil Nano® PGA sheets were identified. The loss of all sheets was defined as an engraftment failure. Multiple logistic regression analysis was conducted to identify whether the PGA-sheet type, application site, defect size and postoperative fasting duration predicted engraftment. RESULTS: Overall, 137 patients were identified (mean age, 73 years; 57% male). The surgeries were conducted with Neoveil® in 66% of the patients; the most common site was the buccal mucosa (25%), and the mean defect size and fasting duration were 709 mm2 and 4 days, respectively. The engraftment rate was 76%. Neoveil Nano® PGA sheets were associated with a 2.8-fold better engraftment rate than Neoveil® (univariate: 87 vs. 70%, P = 0.032; multivariate: 95% confidence intervals = 1.067-7.410, P = 0.036). Other variables, including fasting duration, were not predictive of engraftment. CONCLUSIONS: This is the largest case series of patients with head and neck cancer who underwent fibrin glue-PGA sheet defect coverage. The fasting duration did not influence engraftment. Therefore, early oral intake is not contraindicated in such patients.

DOI： 10.1093/jjco/hyad035

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: We examined whether there were any differences in perioperative complications between patients who mobilized on the first postoperative day (early mobilization) and those who mobilized on the second postoperative day after head and neck reconstruction using free tissue transfer. METHODS: In the control group (n = 74), patients were instructed to mobilize on the second postoperative day (April 2019-March 2020), while in the early mobilization group (n = 101), patients were instructed to mobilize on the first postoperative day (April 2020-March 2021). Mobilization was defined as maintaining a standing position or walking. Clinical data were collected from medical records and retrospectively analyzed. RESULTS: There were no significant differences in clinical background factors, with the exception of intraoperative blood loss volume. The proportion of patients who successfully mobilized on the day of instruction was significantly lower in the early mobilization group (89.1% vs. 98.7%). One case of total flap loss and four cases of partial flap loss occurred in the control group, and three cases of partial flap loss occurred in the early mobilization group. There was no significant difference in partial or total flap loss between the two groups. There were no significant differences in other perioperative complications (wound infection, postoperative bleeding, and delirium) between the two groups. The median postoperative hospital stay was 24.5 and 25.0 days in the control and early mobilization groups, respectively. CONCLUSION: In this study, early mobilization on the first day after head and neck free flap reconstruction was safe and feasible.

DOI： 10.1016/j.bjps.2022.08.047

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

71歳女性。3年前に左上眼瞼、左右頬部に軽度硬結を伴う隆起性小病変が出現し、同部が急激に増大したため当科へ受診となった。初診時、左頬部に16mm、左上眼瞼に6mm、右頬部に3mm大の結節性病変が認められ、左頬部・上眼瞼部腫瘤の組織生検で皮膚粘液癌とされた。以後、治療として左頬部と左上眼瞼部の腫瘍切除術を行い、初回手術14日後に左頬部の皮膚欠損部をcheek rotation flapで、また左上眼瞼部皮膚欠損部をhatchet flapで創閉鎖し、右頬部の皮膚腫瘍を切除・単純縫縮した。目下、術後9ヵ月経過で転移・再発所見なく、良好に経過している。

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We previously reported cases of anterior-neck reconstruction using super-thin and perforator-supercharged skin-pedicled flaps harvested from the pectoral area and back. Here, we reconstructed a neck-scar contracture with a long skin-pedicled flap from the pectoral area that survived without congestion despite not being supercharged with a perforator, as planned. The patient, a 67-year-old man, was admitted to our hospital due to neck-scar contracture after a chemical burn 3 years previously. During surgery, the scar was resected above the platysma. A large, 19 × 6-cm skin-pedicled flap was elevated from the left pectoral area. We planned to supercharge the flap by anastomosing the second intercostal perforator to the flap periphery but could not confirm the perforator intraoperatively. To promote flap survival, we did not elevate the flap pedicle more than absolutely necessary and then manipulated the flap very carefully. The flap survived fully and the contracture was effectively released. Thin flaps are useful for reconstructing exposed areas such as the face, neck, and dorsum of the hands that require good outcomes in terms of both function and aesthetics. However, if the flap is too large, ischemia/congestion could arise in the periphery unless the blood flow is stabilized by attaching a perforator. In our case, supercharging was not possible and we had to resort to careful intraoperative maneuvers to ensure flap survival. This approach was successful and suggests that although supercharging of thin and large flaps is preferred, unexpectedly unsuperchargeable flaps can be rescued by careful and finely tuned surgical judgment and techniques.

DOI： 10.1097/GOX.0000000000003404

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本形成外科学会  

60歳女。右小指の皮下腫瘤感と右小指尺側知覚低下を主訴とした。右小指尺側にTinel徴候陽性の25mm大の弾性硬の腫瘤を認めた。単純MRIでは小指MP関節の掌側、A1靱帯性腱鞘もしくは近傍からの腫瘤が虫様筋や小指球筋を圧排し、T1強調像で低信号、T2強調像で高信号を認め、正常組織への浸潤像が一部疑われた。部分生検で腱鞘線維腫(FTS)の診断であったため、全身麻酔下に腫瘍摘出術を施行した。腫瘍は神経血管束を巻き込むように挟んでいたが分離は可能であり、屈筋腱とは完全に癒着していたため一塊に切除した。病理組織学的診断はFTSであり、裂隙様の血管も存在する線維芽細胞の増加と膠原線維を確認した。術直後から症状は改善傾向にあり、術後3ヵ月現在、合併症を生じず経過良好である。

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: Abnormal scars such as hypertrophic scars (HSs) and keloids are excessively growing scars that exhibit chronic inflammation and capillary vasculogenesis. The lipid mediator sphingosine-1-phosphate (S1P) is important in inflammatory cell recruitment and angiogenesis. Fingolimod (FTY720) is an analog of S1P and thus functionally antagonizes S1P receptors and inhibits the enzyme that produces S1P. We examined the effects of topical FTY720 injections on mechanical force-induced HS progression. METHODS: Mechanical force-induced HSs were generated in C57BL6/J mice by suturing a dorsal incision and applying a stretching device on Days 6, 8, 10, and 12. On Days 8, 10, and 12, intracutaneous FTY720 (10 μM) or control vehicle injections were performed. On Day 14, scar tissues and blood were procured and subjected to histology and flow cytometry. RESULTS: Flow cytometry showed that FTY720 decreased the frequencies of macrophages with M2 predominance in the scars but had no effect on total, CD4+, or CD8a+ T cell frequencies. FTY720 also decreased the vascular endothelial cell frequencies in the scar along with the microvessels, as determined by immunohistochemistry. Compared to the vehicles, FTY720 treatment significantly reduced the gross scar area and the cross-sectional scar area on histology. On the other hand, FTY720 tended to reduce white blood cells and significantly reduced the lymphocyte frequencies in the blood. CONCLUSION: Topical FTY720 induces M2 predominance and impairs angiogenesis. Therefore, its local immunosuppressive mechanisms differ from those of conventional immunosuppressive agents. Topical FTY720 can be a novel therapeutic option for abnormal scars that are difficult to control with corticosteroids. Its lymphocytopenic effects may be limited by careful optimization of the treatment regimen.

DOI： 10.1155/2020/7057195

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本マイクロサージャリー学会  

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記述言語：日本語   出版者・発行元：(一社)日本マイクロサージャリー学会  

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記述言語：日本語   出版者・発行元：(一社)日本マイクロサージャリー学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(一社)日本頭頸部癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本マイクロサージャリー学会  

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記述言語：日本語   出版者・発行元：(一社)日本マイクロサージャリー学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(一社)日本マイクロサージャリー学会  

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記述言語：日本語   出版者・発行元：(一社)日本創傷治癒学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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